AccountId: 011433970860
ContactId: 883f3e54-a49f-4b5b-9f9e-7f7cbb8693eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542869 ms
Total Talk Time (AGENT): 204701 ms
Total Talk Time (CUSTOMER): 155447 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/883f3e54-a49f-4b5b-9f9e-7f7cbb8693eb_20250124T20:31_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[AGENT][NEUTRAL] Hello, this is [PII]. Can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from road office to check out the claim status.
[AGENT][POSITIVE] Hey [PII], how are you doing today?
[CUSTOMER][NEUTRAL] Yeah, I'm fine. What about you?
[AGENT][POSITIVE] I'm doing wonderful, thank you for asking. And I'd love to help you with the claim status today, but do you mind if I grab a good callback number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Thank you very much and what is the member ID number we're looking at today?
[CUSTOMER][NEUTRAL] Yeah, member ID is 02441381.
[AGENT][POSITIVE] Perfect and.
[AGENT][NEUTRAL] Let me get that pulled up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for your patience and would you be able to verify for me please the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, ma'am. My first name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Last name is [PII], and patient date is [PII].
[AGENT][NEUTRAL] Perfect and I see Ms. [PII] right here and what is the date of service on the claim we wanna look at?
[CUSTOMER][NEUTRAL] And that the services.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][POSITIVE] No, take your time.
[CUSTOMER][NEUTRAL] Yeah, uh, and the service is $1021 2024 and the bill amount is $26 even.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Would you be able to verify for me please the name of the provider or I'm sorry, the name of the facility on file?
[CUSTOMER][NEUTRAL] Yeah, facility's name is Suman's Facilities 4915 Norton Healthcare P B V B B L V UCS KY 40241-2832.
[AGENT][NEUTRAL] OK, I'm showing the, I mean.
[AGENT][NEUTRAL] I think this is your claim, but.
[AGENT][NEUTRAL] It does have a different name on that provider. Do you think we could try verifying with the tax ID?
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[AGENT][POSITIVE] Thank you I appreciate that that did match it came up on my side under Community Medical Associates, but I do have.
[CUSTOMER][NEUTRAL] Yeah, yeah, yes. Is that, yeah, that is the second billing, that is the billing provider is Community Medical Associates, [PII].
[AGENT][POSITIVE] Got you.
[AGENT][POSITIVE] Perfect thank you so much I appreciate that and I do have that claim right here um I see that we received it on [PII], and we processed it on [PII]. I have your claim number listed as 352-7486.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And I do show that this claim did deny let me get that reason for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Typos OK um so what I'm seeing here is it says that the maximum benefit table for the state of service has been met.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Number of visits or value for this number?
[AGENT][POSITIVE] Uh, that's a wonderful question. Let me take a look.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It looks like dollar value amount.
[CUSTOMER][NEUTRAL] Dollar. OK. How much is that dollar value for them?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and I do just wanna let you know any benefit information I give you over the phone is always a verification of coverage, never a guaranteed payment, but it looks like they had a maximum benefit amount of $100.
[CUSTOMER][NEUTRAL] OK, $100. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1 2nd, 1 2nd.
[CUSTOMER][POSITIVE] OK, thank you so much for waiting. Can I know when was the last bed date?
[AGENT][NEUTRAL] Um, and I'm so sorry, the date is the claim was submitted, is that what you're asking for?
[CUSTOMER][NEUTRAL] Uh, you said the maximum if it's the dollar value, and it's under, uh, you said under, under the maximum value, but when was the last met for the dollar value?
[AGENT][NEUTRAL] Uh, yeah, let me take a look at that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like it was met on that same date of service [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the same date of service?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, OK, one moment.
[CUSTOMER][NEUTRAL] OK. Uh, whether it is the member responsibility in the $26 a member responsibility?
[AGENT][POSITIVE] OK, yeah, that's a wonderful question. So, um, APL cannot determine patient responsibility, so that's gonna be up to up to the provider.
[CUSTOMER][NEUTRAL] OK, could you please send a copy of COB through this fax?
[AGENT][POSITIVE] Oh, I'd love to, absolutely. Let me pull it up for you.
[CUSTOMER][NEUTRAL] OK. PR, could you please send the PR UP through the fax?
[AGENT][NEUTRAL] Send the what?
[CUSTOMER][NEUTRAL] PR member responsibility, UOB PROB.
[AGENT][NEUTRAL] OK, yeah, so we actually I do have an EOB I can send you but again APL is a supplemental policy, so we do not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, but I can absolutely send you the copy of the EOB for your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah yeah I.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you want me to make that attention to yourself today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm gonna go out.
[CUSTOMER][NEUTRAL] Yeah. The fax number will be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Attention to [PII].
[AGENT][NEUTRAL] All right, and I have that going. Let me repeat that back to you. I have it going to [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's right.
[AGENT][POSITIVE] Perfect, I'm hitting send on that now. You should get something in the next 5 to 15 minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can do to take care of you today, [PII]?
[CUSTOMER][POSITIVE] Yeah, that's all for now. Thank you so much for your kind assistance. Uh, before that, can I get the call?
[AGENT][POSITIVE] Oh, it's my pleasure.
[AGENT][NEUTRAL] Yes, it's gonna be my name.
[CUSTOMER][NEUTRAL] Can I get the call sir?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's my name, [PII], first initial last name, [PII], and then today's date.
[CUSTOMER][NEUTRAL] Yes, go on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day. Happy weekend.
[AGENT][POSITIVE] My pleasure. You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.